Provider Demographics
NPI:1871085951
Name:STEPHENS-BURT, JESSICA CATHRYN (MT-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CATHRYN
Last Name:STEPHENS-BURT
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 SWEETLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-5943
Mailing Address - Country:US
Mailing Address - Phone:518-683-0925
Mailing Address - Fax:
Practice Address - Street 1:78 SWEETLAND AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5943
Practice Address - Country:US
Practice Address - Phone:518-683-0925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA09964225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist